Experts Say Anti-AIDS Drugs Alone Won't Prevent Increase in Infection Rates

Without HIV prevention education, universal access to antiretroviral therapy for patients in resource-poor countries may be limited in efficacy or have unintended consequences, a new study finds. The World Health Organization (WHO), among other agencies, supports ARV access for patients in the developing world, where about 95 percent of people with HIV live. The study authors, who also support universal ARV access, said the lack of infrastructure in those countries may hinder that process.

"And the WHO is envisaging very, very large-scale roll out of antiretroviral therapy where this kind of infrastructure will not be available, and, therefore, the very long extension of life expectancy [that has occurred] in industrialized countries might not be the same [in developing countries]," said the senior author, Rebecca Baggaley of Imperial College London (ICL).

Using Malawi for their model, Baggaley and ICL colleagues found that patients would not do as well on ARV therapy since they tended to wait until they were sick before being diagnosed. In addition, patients lack access to testing, often have poor nutrition, and face adherence issues.

But success in diagnosing people earlier in the disease, in isolation of prevention counseling, can have unintended consequences, said Baggaley. Patients may live longer, healthier lives that include sex, possibly increasing HIV transmission risks.

"This means altogether that actually HIV prevalence increases with antiretroviral therapy," said Baggaley, who cited the experience of the United States, where there is an increase in unprotected sex among gay HIV-positive men. "If we saw an increase in sexual behavior as well, this would increase [prevalence] even further." The lesson, said Baggaley, is that safe-sex counseling is a necessary part of any AIDS control program.

The full report, "Antiretroviral Use in Resource-Poor Settings: Modeling Its Impact," was published in Public Library of Science Medicine (2006;3(4):e179).

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